Most workers compensation and insurance claims are legitimate. When a claim does not add up, however, employers and insurers need objective facts. Fraud increases costs for businesses and honest policyholders alike. A professional investigation helps verify claims fairly and lawfully.
Common Red Flags
Claims may warrant a closer look when there are signs such as:
- An injury reported after a disciplinary action or layoff notice
- No witnesses to an incident that should have been observed
- Inconsistent accounts of how the injury happened
- Reports of the claimant working another job
- Social media activity that appears inconsistent with claimed limitations
- Repeated missed medical appointments
- Tips from coworkers or the public
Red flags do not prove fraud. They indicate that verification may be appropriate.
How Claim Investigations Work
Insurance and workers compensation investigations commonly include:
- Surveillance documenting physical activities in public settings
- Background research, including prior claims and public records
- Review of publicly available social media content
- Activity checks to confirm residence, employment, or business activity
- Witness interviews when appropriate
Surveillance is conducted lawfully from public places. Investigators do not enter private property, use deception to obtain medical information, or contact the claimant in ways that could interfere with the claim.
Objectivity Matters
A professional investigation is fact finding, not a search for a predetermined result. Sometimes the investigation confirms that a claimant is following medical restrictions. That information is just as valuable, because it helps the employer or insurer handle the claim with confidence.
Ohio Workers Compensation
Ohio has its own workers compensation system and rules about fraud. Employers and third party administrators should coordinate investigations with their legal counsel and claims professionals so that evidence is handled appropriately.
Clear Reports
Findings are documented in a written report with time stamped photos and video. Investigators can testify about their observations at hearings or in court when needed.
Disability and Liability Claims
The same investigative methods apply to disability claims, personal injury claims, and liability claims. Verifying the facts protects everyone involved.
Investigations for Employers and Insurers
We work with employers, insurers, third party administrators, and attorneys throughout Ohio, including Youngstown, Warren, Columbus, Akron, and Canton. Visit our private investigation services page or contact us through our service inquiry form.
This article provides general information and is not legal advice.
